Utah clinics hustle to absorb uninsured pregnant women
Josefina was cooking dinner for her husband and 4-year-old daughter when she overheard on the radio that her family medical clinic had closed unsettling news for an uninsured woman eight months into a high-risk pregnancy.
Maya arrived at her childbirth class to find the clinic doors locked. She, too, was just weeks from delivery.
Hundreds of low-income, pregnant women found themselves without care after the abrupt closure of Westview Medical Center in late August.
The West Valley City clinic is under investigation for defrauding Medicaid. Prosecutors allege the clinic and its affiliated billing company, All Medical Billing Inc. coached undocumented immigrants to lie about their citizenship in order to obtain two months of free prenatal care under Utah's Baby Your Baby program.
No charges have been filed. The Attorney General's Office is still sorting through evidence obtained in September through a search warrant.
Meanwhile, health centers throughout Salt Lake Valley are hustling to absorb the clinic's abandoned patients.
They're doing it with no medical histories, charts or lab results. They're offering steep discounts, with no guarantee of payment. Some have increased staffing and extended operating hours to accommodate the mini-baby boom.
"Initially, we were seeing as many as 10 new patients a day," said Linda Stearns, business manager of Oquirrh View Health Center in Taylorsville. "That's a lot to have suddenly coming in. But we're working it out. That's what we do."
One of 11 federally funded community health centers in Utah, Oquirrh View has a mandate to care for the uninsured. Pregnant women get first priority.
And due to the clinic's limited budget, "they pretty much max out our system," said Dexter Pearce, executive director of the nonprofit Community Health Centers Inc. (CHC), which runs Oquirrh View and five other clinics.
CHC was able to take on 150 Westview patients.
Among them were Maya and Josefina, two undocumented immigrants who fear deportation and spoke to The Salt Lake Tribune on condition of anonymity. They are identified by pseudonyms.
The two women liked Westview: It was conveniently located. The staff spoke Spanish and oversaw both women's earlier pregnancies.
"It was a little weird, the turnover in doctors," said Maya through a translator. "But I was comfortable there."
Josefina had a bad experience with one Westview doctor, but she stayed mostly because she liked her daughter's pediatrician.
"When Westview closed, I didn't know what to do, or where else to go," said the 38-year-old through a translator.
Because of her age and a previous cesarean section, her pregnancy is considered high risk. Doctors are also monitoring her for high blood pressure.
How many other patients were displaced remains unknown.
But there is no shortage of health centers stepping up to provide a medical home.
Intermountain Medical Center in Murray has accepted some transfers, according to hospital spokesman Jess Gomez. So has Exodus Healthcare in West Valley City.
The for-profit Copper Canyon Women's Center, an affiliate of Jordan Valley Hospital, even advertised on Spanish-language radio and TV, absorbing 50 Westview women and doubling its patient load in one month.
"For the first time ever, we're seeing active competition for women who are uninsurable," said CHC's Pearce, a trend that started in 2009, before Westview closed.
With the slowing economy, hospitals from Davis County to Utah County have reported significantly fewer births.
"Think about how much medical capacity has been built to accommodate Utah's [notoriously high] birthrate," Pearce said. "Hospitals are counting on pregnant moms filling those maternity wards."
Joseph Bell, a board-certified OB-GYN at Copper Canyon, declined to comment on the quality of care delivered at Westview, saying only, "They ran a lot of people through there, and I really abhor factory medicine."
The Westview transfers were mostly young and healthy. But they present a challenge and liability, "because we haven't been able to get their charts," he said.
Some showed up needing staples removed from their C-section incisions. Others were past their due dates or were already scheduled to be induced.
A few brought in ultrasound images of their babies which were "virtually useless," Bell said. "Ultrasounds are accurate for dating pregnancies between nine and 12 weeks. But after that, they're less reliable, which means, for some women, we had no way to know whether they had reached full term."
Recognizing that many of the women already paid Westview up to $1,200, Copper Canyon is discounting care by 69 percent.
Some patients will qualify to have their deliveries covered under emergency Medicaid, though at a reimbursement rate well below what private insurance pays. And their newborns will be entitled to Medicaid.
"But money has to be secondary at this point," said Lynne Atwood, a certified nurse midwife at the clinic. "We would rather give them care all along, with no payment, than have them go without care and show up later with a sick baby."
Allegations of fraud
Westview Medical Center, 3451 S. 5600 West in West Valley City, is under investigation for allegedly defrauding Medicaid of more than $1 million. Prosecutors say that, in a period of five years, the clinic coached thousands of undocumented immigrants to lie about their citizenship in order to obtain free prenatal care from Baby Your Baby, a program funded by Medicaid.